Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study).

BACKGROUND: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

Cognitive Impairment and Emotional Dysregulation in Offenders.

This study aimed to evaluate the correlation between cognitive function and emotional dysregulation in patients suffering from psychiatric disorders hosted in rehabilitation facilities, but within this sample, there are also perpetrators of violence who are not residents in facilities but are followed in clinics for crimes related to family violence. All patients were administered the rating scale to investigate general impulsivity, perform psychopathological evaluation, evaluate aberrant salience, and conduct a general cognitive assessment.

Primary Psychosis, Geriatric Depression and Cognitive Reserve: Protective Factor and Therapeutic Trajectors.

Cognitive reserve (CR) is essential in reducing natural cognitive decline. Identified in neurodegenerative pathologies, it also increasingly plays a role in the development of the symptomatic processes of numerous psychiatric pathologies. CR could help identify subgroups of elderly patients affected by primary psychosis and mood disorders and evaluate their correlation with diagnostic and therapeutic trajectories. Our observational study assessed the correlation between cognitive reserve and cognitive and psychopathological trajectories in a group of elderly inpatients in health residential centers. After two years of observation, the results indicate a correlation between cognitive reserve levels and psychopathological and cognitive trajectories. No significant variations or correlations were observed between another investigation factor, aberrant salience, and the symptoms in the above trajectories.

The Role of Cognitive Deficits in Emotional Dysregulation: a Study on a Simple of Patients from Psychiatric Rehabilitation Communities.

BACKGROUND: Emotional dysregulation is a common feature across various psychiatric disorders, including personality disorders, mood disorders, substance use disorders, and schizophrenia. It manifests through difficulties in emotion modulation, which can lead to impulsive behaviors, exaggerated emotional reactions, and poor management of negative emotions. Cognitive deficits, particularly those related to executive functions such as inhibition, working memory, and cognitive flexibility, play a crucial role in this process, contributing to a higher vulnerability to emotional dysregulation. This paper focuses on the role cognitive deficits may have in emotional dysregulation. The sample will include both psychiatric patients and offenders undergoing therapeutic rehabilitation in community settings. METHOD: In our observational study, fifty-nine psychiatric inpatients (total mean age: 45.3910.93), distributed by age, gender, and legal provision (offenders and non-offenders) were recruited in several psychiatric rehabilitation centers located in South Italy. We used Aberrant Salience Inventory (ASI), Barrat Impulsiveness Scale Version 11 (BIS-11), Historical-Clinical-Risk Management-20, Version 3 (HCR-20V3), Brief Psychiatric Research Symptoms (BPRS), Verbal fluency tests (VFT) Estimated IQ Short Intelligence Test (T.I.B.), World Health Organization Disability Assessment Schedule 2.0. (WHODAS 2.0). RESULTS: The results highlighted higher impulsivity levels in offenders associated with higher scores on the cognitive performance scales. CONCLUSION: Cognitive deficits are a significant contributor to emotional dysregulation in psychiatric patients, particularly in offender psychiatric patients.

Psychopathological and Therapeutic Trajectories of Inpatients Affected by Mixed States and Bipolar Spectrum Disorders.

In clinical practice, mental health professionals face diagnostic and therapeutic challenges daily. The diagnostic identification of mixed states allows the management of diagnostic and therapeutic trajectories appropriately. In our study, we evaluated 484 patients at a psychiatric rehabilitation center. The initial pre-admission diagnosis of the mixed state of 3.71% (at baseline) increased to 32.23%. The observation period was three years. The therapeutic efficacy of the pharmacological association of Antidepressants (Ads) or Second Generation Antipsychotics (SGAs) with a mood stabilizer (sodium valproate, lithium, lamotrigine, gabapentin, and pregabalin) was evaluated. An improvement in psychopathological symptoms was observed in different groups analyzed. The most significant differences were observed with the association SGAs + mood stabilizer [olanzapine + valproate sodium (p=0.005); risperidone + pregabalin (p=0.072)] and SSRIs + mood stabilizer [escitalopram + valproate sodium (p=0.005), vortioxetine + mood stabilizers (valproate or gabapentin). However, these are preliminary data and are under evaluation.

Neurocognitive Disorders and Cognitive Reserve: a Study on a Psychiatric Rehabilitation Patients Sample.

BACKGROUND: Research on neurocognitive disorders and cognitive reserve in psychiatric rehabilitation patients is crucial to understanding how cognitive function impacts rehabilitation outcomes. Cognitive reserve refers to the brain's resilience to neuropathological damage, and exploring its role in psychiatric patients can provide insights into their varying responses to treatment and recovery potential. Investigating whether there are differences in cognitive reserve and neurocognitive disorders between offenders and non-offenders within psychiatric rehabilitation can help tailor interventions and improve rehabilitation strategies. This study explores cognitive reserve (CR) and neurocognitive disorders (NCDs) in a sample of psychiatric patients within a Psychiatric Rehabilitation Center, with a particular focus on differences between offenders and non-offenders following the closure of Judicial Psychiatric Hospitals in Italy (March 31, 2015). METHOD: In our observational study, were recruited a total of 59 patients (20 females and 39 males, mean age = 45.39 years) from various Psychiatric Rehabilitation Communities in Southern Italy. The patients were assessed using the Structured Clinical Interview for DSM-5 (SCID-5 CV) and a battery of tests, including in particular the Cognitive Reserve Index Questionnaire (CRIq), Brief Psychiatric Rating Scale (BPRS), Aberrant Salience Inventory (ASI) and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). RESULTS: Results indicated significant differences between offenders and non-offenders in cognitive reserve, psychopathological symptoms and personal and social functionality. CONCLUSION: Understanding these distinctions is important for developing specialized therapeutic approaches that address the rehabilitation needs of each group that also include neurocognitive aspects such as cognitive reserve.

Compassion Fatigue, Loneliness, and Hopelessness in Healthcare Workers: What Remains of the COVID-19 Pandemic?

Although the end of the critical phase of the COVID-19 pandemic has been declared, its consequences are still observed in the general population and some categories of workers. HCWs have had to face the battle against this disease on the front lines. In our study, we evaluated the current state of the consequences of the pandemic on compassion fatigue, loneliness, empathy, anxiety, and hopelessness in a group of 71 HCWs from a rehabilitation center. This data, collected in the time of May-June 2024 (T2), was compared in the same sample in 2020 (T0) and 2023 (T1). The results highlighted increased burnout (P-Bonferroni: 0.005) and feelings of loneliness in T2 (P-Bonferroni: 0.005). Importantly, the results of the compassion satisfaction remained stable, providing reassurance about the resilience of HCWs. Secondary Trauma results decreased in T2, indicating less psychological pressure associated with COVID-19 pathology.

Results of the COVID-19 mental health international for the health professionals (COMET-HP) study: depression, suicidal tendencies and conspiracism.

INTRODUCTION: The current study aimed to investigate the rates of anxiety, clinical depression, and suicidality and their changes in health professionals during the COVID-19 outbreak. MATERIALS AND METHODS: The data came from the larger COMET-G study. The study sample includes 12,792 health professionals from 40 countries (62.40% women aged 39.76 ± 11.70; 36.81% men aged 35.91 ± 11.00 and 0.78% non-binary gender aged 35.15 ± 13.03). Distress and clinical depression were identified with the use of a previously developed cut-off and algorithm, respectively. STATISTICAL ANALYSIS: Descriptive statistics were calculated. Chi-square tests, multiple forward stepwise linear regression analyses, and Factorial Analysis of Variance (ANOVA) tested relations among variables. RESULTS: Clinical depression was detected in 13.16% with male doctors and 'non-binary genders' having the lowest rates (7.89 and 5.88% respectively) and 'non-binary gender' nurses and administrative staff had the highest (37.50%); distress was present in 15.19%. A significant percentage reported a deterioration in mental state, family dynamics, and everyday lifestyle. Persons with a history of mental disorders had higher rates of current depression (24.64% vs. 9.62%; p < 0.0001). Suicidal tendencies were at least doubled in terms of RASS scores. Approximately one-third of participants were accepting (at least to a moderate degree) a non-bizarre conspiracy. The highest Relative Risk (RR) to develop clinical depression was associated with a history of Bipolar disorder (RR = 4.23). CONCLUSIONS: The current study reported findings in health care professionals similar in magnitude and quality to those reported earlier in the general population although rates of clinical depression, suicidal tendencies, and adherence to conspiracy theories were much lower. However, the general model of factors interplay seems to be the same and this could be of practical utility since many of these factors are modifiable.

Negative Symptoms and Cognitive Deficits in Primary Psychoses: an Observational Study in a Psychiatric Rehabilitation Centre.

Negative symptoms (NSs) and cognitive deficits (CDs) negatively affect patients' quality of life with primary psychosis. Our observational study evaluated the percentage of NSs in a group of inpatients of a psychiatric rehabilitation facility and the variation of the interaction with CDs during the COVID-19 pandemic. The results showed a significant correlation between NSs and CDs in the first observation period (PANSS - FSNS p=0.001; BNSS p=0.023; Epitrack p=0.00) and a stabilization of the results between the first and second observation periods (PANSS - FSNS: p=0.094; BNSS p=0.466; Epitrack p=0.026).

Stress Work and Hopelessness in Mental Health Workers/Caregivers: an Observational Study in Pandemic and Post COVID-19 Pandemic.

BACKGROUND: WHO has decreed an end to the pandemic crisis from COVID-19. However, the consequences of stress, compassion fatigue, and healthcare workers' expectations are still evident. Also, the hope of ending the problems associated with the pandemic is still present, although the awareness of maintaining a high level of attention is current in the HCWs. METHOD: In our observational study, 102 (65 females, 37 males) mental healthcare workers were evaluated during and post-COVID-19 pandemic. They were divided into different categories of workers: nurses, physicians, psychologists, social assistants, social educators, social health workers, and psychiatric rehabilitation technicians. We used the ProQoL for compassion fatigue, compassion satisfaction, and burnout; BHS for hopelessness. RESULTS: ProQoL data showed a significant increase in compassion satisfaction in post-pandemic (p=0.002) in all professional workers. The same results in burnout and secondary stress subscales (respectively, p=0.018, p=0.000) are evident. The BHS total score indicated that the difference between T0 vs. T1 was not statistically significant (p=0.109). CONCLUSIONS: The collected data during and post-COVID-19 pandemic showed reduced burnout and compassion fatigue in the helping professions. However, in the periods analyzed, no changes in hope are observed.

The Emotional Impact on Mental Health Workers in the Care of Patients with Mental Disorders in the Pandemic and Post COVID-19 Pandemic: a Measure of "Burnout" and "Compassion Fatigue".

BACKGROUND: Emotional pressure, fear, and uncertainties affected healthcare workers (HCWs) who played a significant role during the COVID-19 pandemic. After the pandemic crisis, the consequences on the health of mental HealhCare Workers are still significant. Our work aimed to evaluate burnout and compassion fatigue in HCWs. METHOD: In our observational study, 102 (65 females, 37 males) mental HCWs were evaluated during and post-COVID-19 pandemic. We used the Compassion Fatigue-Short Scale, Balanced Emotional Empathy Scale, and Beck Depression Inventory. RESULTS: Subscale Secondary Trauma Stress of CF-SS demonstrated an increase in the rate in the post-pandemic phase (24.51% in all HCWs). The percentage reached in males was high (37.84%). Instead, the levels of Job Burnout remained constant in the two periods analyzed (during and post-COVID-19). Depressive symptoms remained constant with a prevalence in females of the post-COVID period. CONCLUSION: The results confirm increased stress secondary to the traumatic event, while the levels of job burnout are high. Closely associated with compassion fatigue are levels of empathy that were found to be unchanged.

The Interference of Negative Symptoms of Schizophrenia on Cognitive Domains: a Long-Term Observational Study on the Role of Clozapine.

The negative symptoms of schizophrenia are responsible for patients' worse quality of life. The association with cognitive deficits impairs clinical and psychopathological conditions. Our small 5-year observational study evaluated the efficacy of clozapine in negative and cognitive symptoms in schizophrenia inpatients. The overall results showed a significant improvement in the mean total scores of the BNSS and PANSS (at baseline (T0) vs five years (T3)). The improvement was also in some negative subscales (PANSS Negative Factor subscale) but not in others and the Epitrack tool. The overall results showed that clozapine is a useful therapeutic tool that does not affect the cognitive decline of these patients.

The Role of Fatigue and Satisfaction of Compassion, and Hopelessness in Healthcare Workers in the Alzheimer's Disease in the Post-COVID-19 Pandemic.

The COVID-19 pandemic has left emotional consequences for healthcare workers. Dramatic results are obtained on compassion fatigue, burnout, and hopelessness in healthcare workers (HCWs) of older adults with Alzheimer's disease. Our study evaluated differences in these factors during and after the pandemic in 48 HCWs. The results showed a statistically significant difference in the Satisfaction of Compassion (P=0.014; during vs post-pandemic) and in the subscale of Secondary Trauma (P=0.005) and Burnout (P=0.49) in CFSS. The results were not statistically significant on the BHS scale (P=0.285). However, hopelessness was found in a higher percentage of HCWs at the end of the pandemic than during the pandemic period (respectively: 35.67% vs 31.67%).

Cognitive Deficits in Mood Disorders: Role and Contradictions in Psychiatry.

The principal aim of this work is to reflect about the assessment and management of cognitive deficits in psychiatric disorders, and, particularly, in mood disorders (MDD and BD). The current trend of research and clinical practice is to give more importance to cognitive dysfunctions in psychiatric disorders. There are numerous studies that highlighted the cognitive alterations as the core deficit in MDD and BD, observed across several domains (e.g., executive function, working memory, attention). There are also numerous tools that allow the identification of these cognitive deficits, as well as assessment tools. But are these, really, effective and usable in daily clinical practice? Are they accepted by patients? Could relying only these tools run the risk of forgetting the good clinical practice? Can the doctor-patient (or HCW-patient) relationship and deepening of psychopathological aspects to be marginalized? These and other considerations are carried out in this work.

Dignity-Therapy in Bipolar Disorder and Major Depression: An Observational Study in a Psychiatric Rehabilitation Center.

Dignity Therapy (DT) is a multi-dimensional, brief and individual psychotherapeutic intervention, designed to increase the sense of dignity in patients. The aim of our study was to evaluate the effectiveness of Dignity Therapy in a group of patients suffering from major depressive disorder or bipolar disorder. The results of the study in a small group of patients showed the effectiveness of DT. The PDI (Patient Dignity Inventory Scores) showed a statistically significant difference in the whole group of patients with a reduction in the mean overall score (T0 vs T1 = Mean Difference: 13.700, T-Score: 4.834, Eta squared: 0.709, p: 0.001, statistically significant). However, there is a need to deepen the study to try to offer an opportunity for treatment in this group of patients.

Hope in Psychiatric Patients: An Observational Study in a Psychiatric Rehabilitation Centre.

INTRODUCTION: The COVID-19 pandemic has led to the re-evaluation of some fundamental aspects for the management of emotions and psychological dynamics. Hope and its lack are important factors that have been especially evaluated in caregivers and HCWs. Instead, our study aimed to explore hopelessness among psychiatric rehabilitation center residents with Primary Psychosis. METHODS: We recruited 116 inpatients affected by Primary Psychosis (schizophrenia, bipolar disorder, major depression disorder and personality disorder). Hopelessness was sought through the BHS, during the covid-19 pandemic period. They were compared with data from previous studies on HCWs (HealthCare Workers), in the same period, and in the same centre. RESULTS: The results obtained in this group of patients showed high total scores on the BHS scale (mean total score: 7.28±SD 3.73). These data are significantly higher than those found in HWs in the same pandemic period (mean total score: 3.74±SD 3.62). Among the different disorders the borderline personality disorder patients have presented the highest score (mean total score: 8.00±SD 3.50). CONCLUSION: Understanding resident - and HCWs- level variations in hopelessness may be important for targeting interventions to improve the outcome of residential psychiatric patients.

Metabolic Alterations and Drug Interactions: The Role of the Association between Antipsychotics / Mood Stabilizers and Cognitive Deficits.

Alterations in the metabolic profile are one of the main consequences of the use of drug therapies in psychiatric patients. In particular, dysfunction of the metabolic profile (lipid and glycidic) is very frequent in patients taking antipsychotics, especially second-generation ones, and antidepressants. Similar alterations, albeit, to a lesser extent, were highlighted with the use of mood stabilizers. There are some clinical conditions in which clinicians add antipsychotics and mood stabilizers. Our study analyzed this interaction in 116 inpatients. Data showed an overall increase in metabolic parameters in all patients analyzed. However, no statistically significant differences were found in some subgroups of patients. The correlation between metabolic alterations and cognitive dysfunctions in these patients was also analyzed (not statistically significant).

Loneliness and Hopelesness: Their Role in the Depressive Cases during the COVID Pandemia.

The COVID-19 pandemic has created new problems and presented new challenges for its management. Hope, or rather its absence, social isolation and loneliness are considered risk factors for the development of anxious and depressive symptoms. Health authorities have had to address issues regarding the mental health risks that the pandemic has created. There is numerous scientific evidences of the increase in affective disorders in the last two years. Associated with these disorders, particular characteristics of personality temperament, such as affective temperament, can determine an increased risk especially in some patient populations, such as the elderly, with significant negative consequences on the quality of life and on the onset of mental and organic diseases. The hope of the end of the pandemic has been placed on mass vaccination. After an initial enthusiasm there was a growing concern about its side effects. An adequate information policy is necessary to put an end to concerns about vaccines and thus lead to an increase in hope for the future and an end to social isolation.

The Effect of the Pandemic on the Care of Patients with Mental Disorders: Measure of "Compassion Fatigue" and "Burn-Out" in the Operator.

BACKGROUND: The Covid-19 Pandemic has had a significant impact on psychophysical well-being and the ability to work productively in contexts concerning people's physical and mental care. The helping professions involved have seen an increase in stress levels, a sense of helplessness, fear, pain and social isolation. They are anchored to the hope of being able to return to their normality. METHOD: In this study, 87 mental health operators were evaluated, divided into nurses, psychiatric rehabilitation technicians, educators, social workers, psychologists and doctors, working in two psychiatric care rehabilitation communities in Puglia and Campania in southern Italy. RESULTS: The results obtained with the administration of the scales ProQOL, BHS, Save-9, BDI-II, BEES reported a remarkable impact in nursing and medical professions due to the pandemic. A 11%. burn-out was reported by nurses. CONCLUSIONS: The collected data are comparable to the previous work (Franza et al. 2015, 2020); however, there is no evidence of a high level of burnout in the helping professions involved in this study.

The Emotional Impact of the Operator in the Care of Patients With Mental Disorders during the Pandemic: Measure of Interventions on Compassion Fatigue and Burn-Out.

BACKGROUND: The continuation of the health emergency due to the management of COVID-19 is having a profound effect on all aspects of society, including mental health and physical health. This observational study examined practitioners of psychiatric rehabilitation and therapeutic communities, focusing on the emotional aspects of patient care, in particular the fatigue of compassion, empathy and lack of hope, aspects that could be directly linked to the burnout of health professionals, as found in other similar studies. METHOD: In this study, self-administered scale data was collected in 87 healthcare professionals recruited from 3 different psychiatric rehabilitation communities. In particular, we assessed the fatigue of compassion, vicarious trauma, burnout and hope (hopeless), empathy and depressive symptoms in the two months of May and June 2021. RESULTS: The results obtained after the administration of the following rating scales, ProQOL, BHS, SAVE-9, BDI-II and BEES, showed an overall increase in scores in all professional figures, a significant fatigue of compassion, while the percentage burnout is not present in several groups. The presence of high levels of hope, satisfaction of compassion is indicative of a moderate level of empathy in some professional figures; these high levels can protect workers from the risk of developing work-related stress and depressive symptoms. CONCLUSIONS: The data obtained with this study are not similar to those of previous studies, although they may indicate the importance of factors such as hope, empathy in the care of the patient with psychic disorders in rehabilitation communities, underlining the need for interventions aimed at the emotional management of the care relationship as a tool to improve care and prevent burnout even during times of high stress, such as managing a pandemic.